Reference no: EM133443758
Case Study:
Mr. Wright is a 75-year-old man who is being admitted to a rehabilitation facility directly from hospital after a stay in an acute care medical unit for one week. Mr. Wright's goal is to return to his home in the community; however, he is not yet able to care for himself at a level acceptable and safe for discharge.
Mr. Wright's health history includes congestive heart failure diagnosed 4 years ago, which has been medically managed, and Type 2 diabetes diagnosed at age 54 years. Mr. Wright was a smoker much of his adult life and quit when he was diagnosed with heart failure. He struggles with obesity, and this has made it hard for him to care for himself. Since his wife passed away two years ago, he has struggled to eat healthy meals and does not regularly check his blood sugar levels.
Before his initial admission to hospital, Mr. Wright was experiencing frequent foul-smelling stools for one week. He fell in his bathroom at home and was unable to call for help. His son found him weak and confused after Mr. Wright had been lying on the floor for over 24 hours. He was transported to hospital by ambulance and admitted to a medical unit with dehydration, hyperglycemia, and gastrointestinal infection.
Mr. Wright is 173 cm tall, and his weight is 128.6 kg. On admission to acute care, his blood sugar was 34 mmol/L. There were no ketones present in his urine and he had abnormal serum sodium levels. Mr. Wright was told he had hyperglycemic hyperosmolar nonketotic syndrome, a complication of his diabetes.
Mr. Wright has two grown sons, one of whom lives in the city. His son and two granddaughters are waiting for him as he arrives at the rehabilitation unit. His son states that his dad has been lonely since his wife died, and they are happy he is getting help to manage. Mr. Wright is very tearful and seems anxious during his admission. He states he really wants to get back home where he is more comfortable.
On admission to the rehabilitation unit, his blood sugars are well controlled with scheduled insulin. Mr. Wright is aware that he may still have to take insulin for a short period of time as he learns to better manage his diabetes
Mr. Wright's admission orders for the rehabilitation unit are:
Day/Month/20XX at 1030
AAT
Weigh Monday, Wednesday, Friday.
1800 kcal Diabetic Diet
Chemstrips QID
Humulin R 4 units subcut AC meals
Humulin N 12 units AC breakfast and supper
Metoprolol 12.5 mg po BID
Lasix 20 mg po daily
ASA EC 81 mg po daily
Dr. Ronald Jenkins M.D.
After reviewing the physician's orders, provide a rationale for the daily weight order and the following medication orders based on Mr. Wright's history and health concerns.
Metoprolol 12.5 mg PO BID
Lasix 20 mg PO daily at HS
ASA 81 mg PO daily
Are there any orders that you would question after you have completed your research to care for Mr. Wright? Explain in your answer.
Identify two key members of the rehabilitation team that are essential to consult in Mr. Wright's care in order to achieve his goal of returning home? Provide a rationale for the importance of each team member you choose.
Due to the actions of short-acting insulin, explain when the nurse needs to provide Mr. Wright with his snacks and why? Breakfast is at 0800; Lunch is at 1200; Supper is at 1730.
The nurse prepares Mr. Wright's morning medications before breakfast and, upon entering the room, Mr. Wright states that he is not feeling well and is not going to eat anything for breakfast. What action should the nurse take at this time and why?
Later in the afternoon, Mr. Wright calls the nurse to his room. He is very diaphoretic and shaky. He tells the nurse he feels terrible and his heart feels like it is racing.
What does the nurse suspect is going on and why?
What is the nurse's first priority action?